Wyniki wyszukiwania - Biblioteka Nauki

1

Hypertension Crisis in Adrenal Surgery and Treatment of Postoperative Hypotension

100%

Otto M. , Dzwonkowski J. , Januszewicz A. , Pęczkowska M. , Kański A. , Kasperlik-Załuska A. , Rosłonowska E. , Szmidt J.

Polish Journal of Surgery

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2010

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tom 82

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nr 4

199-211

EN

The aim of the study was to present our experience in the treatment of pheochromocytoma, which can have untypical manifestations or their complete lack. Surgery still is the main treatment. Since introducing minimally invasive method the operative choice between open and videoscopic still remains.The proper diagnosis, preparation and surgical treatment allow to avoid serious cardiovascular complications. In the treatment, pre-or intraoperative hypertensive crisis and hypotension appearing after removing the tumor are the important issues. Based on our study from 29.10.1997 to 31.01.2009 authors are showing methods and principles of preparation and the intra- and post-operative complications associated with performed operation.Additionally the problem of pheochromocytomas, clinically asymptomatic, so-called silent pheochromocytoma is discussed. Evaluated material consisted of 125 patients with pheochromocytoma. 32 (25,6%) were operated by open, classical method, and 93 (74.4%) laparoscopically via lateral transperitoneal approach.Conclusions. 1. The course and the result of surgical treatment of pheochromocytomas depend on proper diagnosis and preoperative preparation. 2. Laparoscopic adrenalectomy through lateral transperitoneal approach should be acknowledge as the referential operation in the treatment of pheochromocytoma. 3. Clinically asymptomatic pheochromocytoma require routine preparation similarly to other forms of pheochromocytoma.

2

Qualification and Operative Difficulties of Laparoscopic Adrenalectomy

100%

Otto M. , Dzwonkowski J. , Jędrasik M. , Ciąćka T. , Górnicka B. , Życińska K. , Szmidt J.

Polish Journal of Surgery

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2010

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tom 82

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nr 1

38-46

EN

Laparoscopic adrenalectomy (LA) became referential in the treatment of adrenal pathology. However in the majority of tumors biochemical markers and imaging examinations aren't reliable to evaluate existences of the malignant process before the operation. Therefore complete resection of the adrenal gland, without damaging the capsule of the tumor remains as a significant problem.The aim of the study was to introduce the problem involving the qualification of the patients for laparoscopic adrenalectomy, and concerning the post-operative histopathologic evaluation, as well as technical aspects of the conducted laparoscopy.Material and methods. These problems are being discussed based on our experience in laparoscopic adrenalectomy. In the period 29.10.1997 - 31.01.2009 472 laparoscopic adrenalectromies were carried out via lateral transperitoneal approach. Among 457 operated patients in 13 (2.8%) conversion was necessary.Results. The malignant lesions were in 22 (4.8%) patients. 11 (2.4%) had metastases from other origin, 1 (0.2%) had Cushing's syndrome and 3 (0.6%) had pheochromocytomas. In the incidentaloma group 6 (13.1%) primary ardenocortical carcinoma and 1 (0.2%) angiosarcoma were identified.Conclusions. Laparoscopic adrenalectomy via lateral transperitoneal approach is a sufficient and safe surgical treatment of adrenal pathology.

3

Laparoscopic Adrenalectomy - Assessing the Learning Curve

100%

Fiszer P. , Toutounchi S. , Pogorzelski R. , Krajewska E. , Cieśla W. , Skórski M.

Polish Journal of Surgery

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2012

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tom 84

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nr 6

293-297

EN

Laparoscopic adrenalectomy (LA) has become the "gold standard" for treatment of most of adrenal tumors in last few years. It has many benefits comparing to open surgery, but still is considered as complicated procedure requiring experienced surgical team.The aim of the study was to assess the learning curve of laparoscopic adrenalectomy and the outcome of the first consecutive 154 LA.Material and methods. 154 consecutive patients undergoing LA between 2007 and 2010 were reviewed. Collected data included: patients demographics, clinical and histological diagnosis, side and length of operation, conversions to open surgery, complications and hospitalization time. Learning curve was evaluated by dividing all patients into three groups (group I - first 50 patients, group II - second 50 patients and group III last 54 patients). Differences between the groups were analyzed.Results. There were 154 LAs performed. Indications for LA were hormonally inactive adrenal adenoma(n=57), Conn's syndrome (n=30), Cushing's syndrome (n=28), pheochromocytoma (n=27), adrenal cyst (n=8), and others (n=4). Mean tumor size was 45.28 mm. There were 79 left-sided and 75 right-sided procedures and the average time of hospitalization was 4.64 days. Mean operative time was statistically different between the groups (216.2 min. - 164.6 min. - 131.9 min.; p<0.01) as well as the number of conversions to open surgery (18% - 4% - 3.7%; p=0.013). There was not any significant difference in the number of complications between analyzed groups (2% - 2% -3.7%).Conclusion. To improve the outcome of LA it is necessary to perform approximately 40 to 50 procedures.

4

Hypertension Crisis in Adrenal Surgery and Treatment of Postoperative Hypotension

100%

Otto M. , Dzwonkowski J. , Januszewicz A. , Pęczkowska M. , Kański A. , Kasperlik-Załuska A. , Rosłonowska E. , Szmidt J.

Polish Journal of Surgery

|

2010

|

tom 82

|

nr 4

199-211

EN

The aim of the study was to present our experience in the treatment of pheochromocytoma, which can have untypical manifestations or their complete lack. Surgery still is the main treatment. Since introducing minimally invasive method the operative choice between open and videoscopic still remains.The proper diagnosis, preparation and surgical treatment allow to avoid serious cardiovascular complications. In the treatment, pre-or intraoperative hypertensive crisis and hypotension appearing after removing the tumor are the important issues. Based on our study from 29.10.1997 to 31.01.2009 authors are showing methods and principles of preparation and the intra- and post-operative complications associated with performed operation.Additionally the problem of pheochromocytomas, clinically asymptomatic, so-called silent pheochromocytoma is discussed. Evaluated material consisted of 125 patients with pheochromocytoma. 32 (25,6%) were operated by open, classical method, and 93 (74.4%) laparoscopically via lateral transperitoneal approach.Conclusions. 1. The course and the result of surgical treatment of pheochromocytomas depend on proper diagnosis and preoperative preparation. 2. Laparoscopic adrenalectomy through lateral transperitoneal approach should be acknowledge as the referential operation in the treatment of pheochromocytoma. 3. Clinically asymptomatic pheochromocytoma require routine preparation similarly to other forms of pheochromocytoma.

5

Laparoscopic Transperitoneal Approach to Adrenal Gland Malignancies

100%

Rembiasz K. , Budzyński A. , Kulawik J. , Matłok M. , Migaczewski M. , Hubalewska-Dydejczyk A. , Gołkowski F.

Polish Journal of Surgery

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2009

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tom 81

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nr 12

609-618

EN

Even though there is not enough good data, the use of laparoscopic approach in malignant disease is regarded by some controversial issue. On the other hand it seems that transperitoneal access to the adrenal gland allows for effective and safe oncological removal of adrenal gland neoplasms.The aim of the study was to present our experience with the use of transperitoneal approach in patients with adrenal gland malignancies.Material and methods. From March 2003 till May 2009 we performed 200 laparoscopic transperitoneal adrenalectomies. There were 82 hormonally silent tumors (1.5-14 cm in diameter) and 118 hormonally active (63 pheochromocytomas, 26 Conn's syndrome, 25 Cushing's syndrome and 4 virylizing tumors).Results. 197 procedures were completed laparoscopically and 3 were converted (including one for inability to assess resectablility of the tumor). 14 tumors (7%) were overtly malignant; 7 arising form the adrenal (adrenal cortex - 3, pheochromocytoma - 3, lymphoma - 1) and 7 metastatic (squamous cell cancer of the lungs - 2, clear cell carcinoma of the kidney - 2, collecting duct carcinoma of the kindey - 1, hepatocellular cancer - 1, NET lung tumor - 1). Further 19 tumors (9.5%) were assessed histologically as potentially malignant (pheochromocytomas - 16, tumors of neural origin - 2, oncocytomas - 1). One malignant tumor was unresectable other were operated radically. Progression of the cancer was observed in 3 patients with metastatic tumors.Conclusions. Laparoscopic transperitoneal adrenalectomy allows for safe and radical removal of adrenal gland malignancies. Longer follow-up and larger patients volume are needed for better evaluation of long-term results.

6

Posterior Retroperitoneoscopic Adrenalectomy - Clnical Evaluation of the Method Based on the Four-Year Experience

88%

Barczyński M. , Konturek A. , Cichoń S. , Gołkowski F. , Hubalewska-Dydejczyk A.

Polish Journal of Surgery

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2008

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tom 80

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nr 9

446-454

EN

The aim of the study was to present the authors' four-year experience in employing posterior retroperitoneoscopic adrenalectomy according to Walz (PRA) in surgical treatment of adrenal tumors up to 6 cm in size.Material and methods. A prospective analysis included 83 procedures of unilateral PRA (40 rightsided and 43 left-sided adrenalectomies) performed in patients (the M:F ratio = 22:61; mean age 58.1±10.3 years; mean tumor size 41±14 mm) operated on in the Department in the period from January 2004 to December 2007. Indications for surgery included: glucocorticoid adenomas (10), aldosteronomas (18), pheochromocytomas (16) and hormonally inactive adrenal cortex tumors (39). The operators used the PRA surgical technique according to Walz. The learning curve was evaluated taking into consideration the operative time, percentage of conversions and complications. The statistical analysis assessed the correlation between the operative time and body mass index (BMI), location and size of the tumor and its hormonal activity. The results of surgical treatment employed in patients with hormonally active tumors were evaluated in a 6-month follow-up.Results. The mean operative time was 73.7±22.3 min. A single conversion (1.2%) was required, as well as a single early reoperation (1.2%) due to bleeding. Following the initial 20 operations with the mean operative time of 86.5±34.6 min, the mean operative time of the remaining 63 procedures was 69.7±14.9 min (p=0.046) and did not exceed 90 min in any case. No correlation was noted between the operative time and BMI, tumor location and size. The procedures performed in patients with pheochromocytomas were not significantly longer in comparison to operations in hormonally inactive adrenocortical adenomas. Normalization of arterial blood pressure was achieved in all the patients with pheochromocytomas, aldosteronomas and subclinical glucocorticoidism aged below 50 years and with less than one-year history of secondary hypertension.Conclusions. Despite its seeming complexity resulting from operating in an "upside down" surgical field, the PRA surgical technique is easy to master and safe, also during the learning period. After the surgeon has performed approximately 20 operations, the operative time does not exceed 90 min. PRA is worthy of recommending in the case of adrenal tumors qualified for surgical treatment and not exceeding 6 cm in size.

7

Cystic Adrenal Lesions - Analysis of Indications and Results of Treatment

75%

Major P. , Pędziwiatr M. , Matłok M. , Ostachowski M. , Winiarski M. , Rembiasz K. , Budzyński A.

Polish Journal of Surgery

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2012

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tom 84

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nr 4

184-189

EN

Cysts are a rare pathology of adrenal glands. As the development of new diagnostic techniques takes place, the occurrence of adrenal cystic lesions has been rapidly increasing. The majority of them are solid adrenal lesions, but localized fluid collections are also more frequently diagnosed. In case of solid adrenal lesions, there are straight indications for surgery, but on the other hand there are no clear guidelines and recommendations in case of adrenal cysts.The aim of the study was to analyze surgical methods and evaluate treatment effects in patients who were qualified for laparoscopic adrenalectomy due to adrenal cystic lesions.Metarial and methods. Identical criteria were used to qualify patients with solid and cystic lesions of the adrenal gland for surgery. Out of the whole number of 345 patients who underwent laparoscopic surgery for adrenal tumors, 28 had adrenal cysts. 16 of them (57%) were women and 12 (43%) men. The average age of the studied group was 46.4 years (25-62 years). The average cyst diameter in CT was 5.32 cm (1.1-10 cm). Most of the lesions were hormonally inactive (22 patients), but in 6 cases increased level of adrenal hormones was observed.Results. Pathological analysis revealed 4 (14%) pheochromocytomas and 2 (7%) dermoid cysts. In case of 22 (79%) patients, the postoperative material was profiled by pathologists as insignificant according to potential neoplasmatic transformation risk: 5 (17.5%) - endothelial vascular cysts, 3 (11%) endothelial lymphatic cysts, 7 (25.5%) pseudocysts, 3 (11%) simple cysts, 2 (7%) bronchogenic cysts, 1 (3.5%) - cortical adenoma and 1 (3.5%) cyst was of myelolipoma type.Conclusions. Based on the performed research and previous experience in treating patients with adrenal lesions we can conclude that application of the same evaluating algorithm for both cystic and solid lesions is valid.

8

Adrenal Tumors - Diagnostics and the Factual Situation

75%

Krajewska E. , Toutounchi S. , Fiszer P. , Cieśla W. , Pogorzelski R. , Bednarczuk T. , Cieszanowski A. , Łoń I. , Skórski M.

Polish Journal of Surgery

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2012

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tom 84

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nr 4

208-213

EN

The study presented three cases of patients diagnosed with adrenal tumors subject to surgical intervention during the past 6 months in our Department. The patients presented with radiological diagnostic difficulties, as to the character and location of the primary tumor.The aim of the study was to demonstrate differences between radiological examination results and the factual situation observed during the adrenalectomy. In all the presented cases patients' were subject to laparoscopic intervention. In two cases conversion to open surgery was necessary. The histopathological results of the surgically removed samples were as follows: leiomyoma, myoperycytoma and pheochromocytoma. In selected cases imaging examinations might be of limited value, especially when determining the character and location of the primary lesion of the adrenal gland.